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General NPI Number Information
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NPI Number | 1932523032
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Entity Type | Organization
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Legal Business Name | MARLO WATSON
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 2101 GARNER RD
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City | RALEIGH
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State | NC
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Zip | 27610-4687
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Country | US
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Telephone | 919-889-1559
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Fax |
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Provider Business Mailing Address
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Address Line | 702 NEUSE RIDGE DR
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City | CLAYTON
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State | NC
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Zip | 27527-6692
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Country | US
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Telephone | 919-889-1559
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Fax |
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Authorized Official
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Title or Position | SUBSTANCE ABUSE COUNSELOR
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Name | MS. MARLO R WATSON
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Credential | LCAS
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Telephone | 919-889-1559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2969
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License Number State | NC
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